NPIMap

Organization Active NPI

Life Bridges, Inc

  • Intellectual Disabilities Intermediate Care Facility
  • Cleveland, TN
National Provider Identifier
1952554834
Registry record updated Apr 26, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X
Legal business name
LIFE BRIDGES, INC
Practice address
4755 Frontage Rd NW
Cleveland, TN 37312-2910
Phone
(423) 479-5909
Fax
(423) 479-1492
NPI assigned
Oct 23, 2008
Reactivated
Jul 19, 2022
Last updated
Apr 26, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 26, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Diana Lynn Jackson
Title
Ceo
Phone
(423) 303-1933

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Intellectual Disabilities Intermediate Care Facility 315P00000X Primary

Addresses

Primary practice location

4755 Frontage Rd NW
Cleveland, TN 37312-2910

Mailing address

PO Box 29
Cleveland, TN 37364-0029
Phone (423) 472-5268

Other names 1

  • Wright House Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

NPI to CCN mapping 1

The Medicare certification numbers (CCNs) connected to NPI 1952554834. Details of each certification follow.

  • CCN 44G091 Intermediate care facility for individuals with intellectual disabilities · Active · Name & address match · Details

Intermediate care facility for individuals with intellectual disabilities certification: CCN 44G091

Name & address match This certification has no NPI in the Medicare enrollment files. CMS publishes enrollment files for six facility types only, so it was connected to this NPI by matching the name and address CMS publishes for it.

Legal name
LIFE BRIDGES WRIGHT HOUSE
Certification status
Active
Provider type (POS)
Intermediate care facility for individuals with intellectual disabilities
Participating since
Oct 10, 1995
Last certification
Aug 26, 2025
Beds
6
Ownership / control type
Private (non-profit)
Facility address
4755 Frontage Road
Cleveland, TN 37312

National Provider Directory

National Provider Directory
Tax ID family
Life Bridges Inc6 organizations share this tax ID, including this one

Other organizations with this tax ID 5

Organizations that report the same tax identification number in the National Provider Directory.

Locations

2611 Bower Ln SE
Cleveland, TN 37311

4755 Frontage Rd NW
Cleveland, TN 37312
Phone (423) 479-5909

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1224720000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1682467200000",
    "number": "1952554834",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 29",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373640029",
            "telephone_number": "423-472-5268",
            "fax_number": "423-479-1492"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4755 FRONTAGE RD NW",
            "city": "CLEVELAND",
            "state": "TN",
            "postal_code": "373122910",
            "telephone_number": "423-479-5909",
            "fax_number": "423-479-1492"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LIFE BRIDGES, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-10-23",
        "last_updated": "2023-04-26",
        "certification_date": "2023-04-26",
        "deactivation_date": "2022-02-18",
        "reactivation_date": "2022-07-19",
        "status": "A",
        "authorized_official_last_name": "JACKSON",
        "authorized_official_first_name": "DIANA",
        "authorized_official_middle_name": "LYNN",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "423-303-1933"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Wright House",
            "code": "5",
            "type": "Other Name"
        },
        {
            "organization_name": "Wright House",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Cleveland, TN

Sources for this page

Verify at the official NPI Registry.